Introduction. Results from St. Jude and M. D. Anderson, USA, suggested that AML children < 10 years have significantly better outcome than patients aged 10–21 years. Similarly, the Medical Research Council, UK, showed superior survival in children < 10 years due to a lower relapse rate compared to 10 – 15 year olds. We describe the AML outcome by age in the Nordic countries.

Patients. Within the population based NOPHO AML protocols (NOPHO-AML 93 and NOPHO-AML 2004) we treated 403 patients aged 0 – 18 years from 1993 – 2007. Patients with Down syndrome and AML-M3 were excluded. The children were divided into three age groups; 0 –1 year (27%), 2 –9 years (41%) and 10+ years (32%). The oldest age group had a male preponderance. MLL-aberrations were more common among the youngest and t(8;21) among the oldest. FAB-type M5 was seen in 35% of 0–1 year olds versus only in 16% of children aged 10+.

0 – 1 year
 n= 1092 –9 years
 n = 16510 – 18 years
 n = 129
Boys/girls 44/67 = 0.67 80/87 = 0.94 80/49 = 1.63 p = 0.01 
WBC>100×109/L 18 (17%) 14 (9%) 18 (14%) p = 0.10 
Cytogenetics
 t(8;21) 
 t(9;11) 
 Other MLL 1 (1%)
 14 (13%)
 21 (19%) 24 (15%)
 12 (7%)
 16 (10%) 15 (12%)
 9 (7%)
 9 (7%) p = 0.01
 p = 0.39
 p = 0.03 
FAB type
 M4
 M5 22 (20%)
 38 (35%) 32 (19%)
 31 (19%) 26 (20%)
 21 (16%) p = 0.96
 p = 0.00 
Protocol
 NOPHO-AML 93
 NOPHO-AML 04 75 (25%)
 34 (32%) 125 (42%)
 40 (37%) 96 (32%)
 33 (31%) p = 0.4 
0 – 1 year
 n= 1092 –9 years
 n = 16510 – 18 years
 n = 129
Boys/girls 44/67 = 0.67 80/87 = 0.94 80/49 = 1.63 p = 0.01 
WBC>100×109/L 18 (17%) 14 (9%) 18 (14%) p = 0.10 
Cytogenetics
 t(8;21) 
 t(9;11) 
 Other MLL 1 (1%)
 14 (13%)
 21 (19%) 24 (15%)
 12 (7%)
 16 (10%) 15 (12%)
 9 (7%)
 9 (7%) p = 0.01
 p = 0.39
 p = 0.03 
FAB type
 M4
 M5 22 (20%)
 38 (35%) 32 (19%)
 31 (19%) 26 (20%)
 21 (16%) p = 0.96
 p = 0.00 
Protocol
 NOPHO-AML 93
 NOPHO-AML 04 75 (25%)
 34 (32%) 125 (42%)
 40 (37%) 96 (32%)
 33 (31%) p = 0.4 
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Results. Almost half of the patients experienced events during follow-up. Types of events, event-free survival (EFS), and overall survival (OS) are shown in the table.

0 – 1 year n= 1092 –9 years n = 16510 – 18 years n = 129
Induction death 2 (2%) 4 (2%) 3 (2%) p = 0.9 
Resistant disease 2 (2%) 2 (1%) 9 (7%) p = 0.01 
Death in CR 6 (6%) 4 (2%) 8 (6%) p = 0.2 
Relapse 34 (31%) 64 (39%) 42 (33%) p = 0.4 
5-year EFS 57% 54% 48% p = 0.5 
5-year OS 68% 68% 64% p = 0.7 
0 – 1 year n= 1092 –9 years n = 16510 – 18 years n = 129
Induction death 2 (2%) 4 (2%) 3 (2%) p = 0.9 
Resistant disease 2 (2%) 2 (1%) 9 (7%) p = 0.01 
Death in CR 6 (6%) 4 (2%) 8 (6%) p = 0.2 
Relapse 34 (31%) 64 (39%) 42 (33%) p = 0.4 
5-year EFS 57% 54% 48% p = 0.5 
5-year OS 68% 68% 64% p = 0.7 
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Conclusion. Older children are more often male, more frequently have t(8;21) and less often M5-subtype or MLL-aberrations. The OS and EFS are similar among all ages. However, older children more often have resistant disease. The risk of death during induction and relapse is similar.

Topics:
boys, child, down syndrome, follow-up, girls, medical research, myeloblastic leukemia, pediatric acute, scandinavia, cytogenetics

Disclosures: No relevant conflicts of interest to declare.

Author notes

Corresponding author

2008, The American Society of Hematology
2008
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